From Centers for Disease Control and Prevention, Atlanta, Georgia, and Quest Diagnostics Nichols Institute, San Juan Capistrano, California.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Acknowledgment: The authors thank Dr. Monina Klevens for her valuable input in developing the study objectives and design and Ms. Laurie Barker for providing statistical advice and her analysis of NHANES data from 2003 to 2012. They also thank state and local health departments that collect data from a range of case ascertainment sources and report them to the CDC NNDSS and Center for Surveillance, Epidemiology, and Laboratory Services, which is responsible for preparing and aggregating state-based NNDSS data for dissemination.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol: National viral hepatitis surveillance as performed by the CDC. Statistical code: Available from Ms. Ly (e-mail, KathleenLy@cdc.gov). Data set: Viral hepatitis surveillance data in the NNDSS are not classified as public use. Interested readers who wish to obtain viral hepatitis case data must contact individual state health departments to obtain the data. Summarized viral hepatitis case count data by state and year may be found within CDC annual viral hepatitis surveillance reports at www.cdc.gov/hepatitis/statistics/index.htm. Quest Diagnostics Health Trends data are proprietary data and therefore must be obtained directly through Quest Diagnostics.

Abstract

In the United States, hepatitis C virus (HCV) infection has increased among young persons who inject drugs, but the extent of this epidemic among reproductive-aged women and their children is unknown.

Objective:

To estimate numbers and describe characteristics of reproductive-aged women with HCV infection and of their offspring.

Design:

Analysis of the National Notifiable Diseases Surveillance System (NNDSS) from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014.

Setting:

United States.

Participants:

171 801 women (aged 15 to 44 years) and 1859 children (aged 2 to 13 years) with HCV infection reported to the NNDSS; 2.1 million reproductive-aged women and 56 684 children who had HCV testing by Quest Diagnostics.

Measurements:

NNDSS HCV case reports and Quest laboratory data regarding unique reproductive-aged women and children who were tested for HCV infection.

Results:

The number of reproductive-aged women with acute and past or present HCV infection in the NNDSS doubled, from 15 550 in 2006 to 31 039 in 2014. Of 581 255 pregnant women tested by Quest from 2011 to 2014, 4232 (0.73% [95% CI, 0.71% to 0.75%]) had HCV infection. Of children tested by Quest, 0.76% (CI, 0.69% to 0.83%) had HCV infection, but the percentage was 3.2-fold higher among children aged 2 to 3 years (1.62% [CI, 1.34% to 1.96%]) than those aged 12 to 13 years (0.50% [CI, 0.41% to 0.62%]). Applying the Quest HCV infection rate to annual live births from 2011 to 2014 resulted in an estimated average of 29 000 women (CI, 27 400 to 30 900 women) with HCV infection, who gave birth to 1700 infants (CI, 1200 to 2200 infants) with the infection each year.

Limitations:

Only a fraction of HCV infections is detected and reported to the NNDSS. Quest data are potentially biased, because women who are asymptomatic, do not access health care, or have unreported risks may be less likely to be tested for HCV infection.

Conclusion:

These data suggest a recent increase in HCV infection among reproductive-aged women and may inform deliberations regarding a role for routine HCV screening during pregnancy.